Abstract
Health literacy (HL) and patient activation (PA) are necessary foundations to engage patients in self-management intervention. Each concept plays a unique role in improving access to the effective self-management of chronic disease. In this cross-sectional study, we examined the levels and determinants of HL and PA among the multi-morbid COPD patients in Nepal. We conducted interviews with a simple random sample of 238 multi-morbid COPD people from July 2018 to January 2019. The questionnaire included sociodemographic profiles, five domains of the Health Literacy Questionnaire (HLQ), 13-item Patient Activation Measure (PAM) and patient's illness perception by Brief Illness Perception Questionnaire (BIPQ). Multivariable logistic regression was used to examine the associations. Most people with COPD had low health levels across each of the five domains of the HLQ. The proportion of people with low literacy level across each of the domains was: (i) feeling understood and supported by healthcare providers (79.0%), (ii) having sufficient information to manage my own health (76.5%), (iii) social support for health (77.3%), (iv) ability to find the good health information (75.2%), and (v) understand the health information well enough to know what to do (74.8%), respectively. The majority of patients also reported low levels of patient activation (level 1: 81.5%; level 2: 11.8%), with only 6.7% (level 3: 5%; level 4: 1.7%) reported higher patient activation level. We found significant associations between poor HL levels in the HLQ domains and having no education, being female or from Indigenous and Dalits communities, and having a monthly family income of less than USD176. Having no education and poor illness perception were significantly associated with poor activation level on PAM scale. A high proportion of multi-morbid COPD peoples had low levels of HL and were less activated than what would be required to self-manage COPD. These were in turn associated with socioeconomic factors and poor illness perception. The findings from this study are being used to design a COPD self-management program tailored to the low health literate population.
Highlights
Health literacy (HL) and patient activation (PA) are necessary foundations to engage patients in self-management intervention
A high proportion of multi-morbid Chronic Obstructive Pulmonary Disease (COPD) peoples had low levels of HL and were less activated than what would be required to self-manage COPD
COPD (Chronic Obstructive Pulmonary Disease) is a life-threatening lung disease characterised by persistent airflow limitation that interferes with normal breathing and is fully nonreversible [1]
Summary
We conducted interviews with a simple random sample of 238 multi-morbid COPD people from July 2018 to January 2019. This was a community-based prospective cross-sectional study among multi-morbid COPD adults living in two rural municipalities of Sunsari district, Nepal. The list of the 576 individuals (296 from rural municipality A and 280 from rural municipality B considering the probability proportion to size) was prepared before conducting the field work, i.e., collecting the patient records from primary health care center (PHC) and health posts (HPs) of the study area. 250 people with COPD were selected randomly from the list of eligible subjects. 250 people with COPD were selected randomly from the list of eligible subjects. 238 people with COPD met the eligibility criteria for this study and were interviewed by the two trained interviewers in the community setting
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